Case Management Program
This program is voluntary and confidential, designed for members of FHC of Puerto Rico, Inc. (FHC) who receive mental health services. Our approach to the Case Management Program is a collaborative process of assessment, planning, facilitation, and advocacy for options and services that meet individual health needs through communication and available resources to promote quality and cost-effective outcomes.
Program Goal
The goal is to increase the adaptive capacities and functioning level of members by providing them with tools that allow them to live a recovery process in the least restrictive levels of care, thereby improving their quality of life and that of their families.
Strategies to Achieve the Goal
- Conduct an initial assessment.
- Evaluate medication safety.
- Educate the member about their rights and responsibilities, the complaint and grievance process, and the right to refuse Case Management Program services.
- Help the member develop an individualized recovery plan.
- Keep the member informed about the different service options available for their recovery.
- Facilitate the implementation of the individualized recovery plan.
- Maintain communication with physical health providers about the member's medical history, functioning level, services provided, and individualized recovery plan.
- Establish links with various community resources, such as support groups, agencies, and programs.
- Provide practical coordination of services after discharge.
- Help the member access community services.
- Assist the member in being functional in the roles they have chosen. The case manager includes family and community resources in interventions.
- Advocate for the member to obtain quality medical, vocational, educational, and recreational services.
- Help the member develop skills to be functional at home, work, family, and community.
- Ensure continuity of the individualized recovery plan by providing follow-up calls, communication with providers, and others involved in the member's recovery.
- Offer psychoeducation modules to help the member and family develop self-help skills for daily living activities.
- Visit the member at home as needed to provide support and follow-up on the goals of the individualized recovery plan and the integration of family and other significant individuals.
Referral Process
The referral process begins by completing the referral form, as well as any other type of verbal or written communication to request an admission evaluation to the Case Management Program. It is the responsibility of the case manager or supervisor to evaluate the referral and determine if the person meets the admission criteria. Referrals are accepted from the following sources:
- Discharge planners: Discharge planners can refer members to the Case Management Program through the following link on the FHC website (Click here), or through the consultation process during frequent contacts with FHC clinical department staff.
- Mental Health Professional: Mental health professionals are informed about their ability to refer through the following link on the FHC website (Click here). Professionals are informed through educational sessions offered to providers by FHC. The mental health provider can also contact FHC by phone to make the referral.
- MCS Classicare: 1-800-760-5691
- MCS Life: 1-866-627-4327
- Triple S Federal: 1-800-660-4896
- Municipality of Guaynabo: 1-866-808-4614
The Case Manager Offers the Member
The case manager offers the member:
- A professional service that guarantees confidentiality, in accordance with Law 408 and the Health Insurance Portability and Accountability Act (HIPAA).
- Work with the member to achieve an optimal level of functioning in the least restrictive treatment.
- The opportunity to contact public agencies that help the member deal with social stressors.
- Individualized and personalized management.
- A link between the member and their mental and physical health providers to ensure quality service.
The Case Management Program does not replace the member's treatment. It is designed to support mental and physical health treatment services. It is expected that the member and their family will commit not only to the program but also to their recovery and treatment, complying with the recommendations offered by both their health providers and the case manager.
